Ranibizumab for macular edema due to retinal vein occlusions: Implication of VEGF as a critical stimulator
Ranibizumab for macular edema due to retinal vein occlusions: Implication of VEGF as a critical stimulator
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DOI：
10.1038/mt.2008.10
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发表时间：
2008-04-01
影响因子：
12.4
通讯作者：
Arron, Joseph R.
中科院分区：
文献类型：
--
作者：
Campochiaro, Peter A.;Hafiz, Gulnar;Arron, Joseph R.
黄斑水肿是视网膜中央静脉阻塞(CRVO)或视网膜分支静脉阻塞(BRVO)患者视力丧失的主要原因。目前尚不清楚有多少是由于梗阻引起的流体动力学变化，有多少是由于化学介质造成的。CRVO(n=20)或BRVO(n=20)所致黄斑水肿患者被随机分为3组，分别每月注射0.3或0.5 mg的雷尼比珠单抗。在主要终点，第3个月，CRVO组在4m时阅读字母的中位数改善分别为0.3 mg组17个和0.5 mg组14个，BRVO组分别为10个和18个。光学相干断层扫描(OCT)显示，与注射0.3毫克相比，注射0.5毫克雷比珠单抗往往会导致持续时间更长的视网膜中央增厚更快地减少，但在3个月内，所有四个治疗组的过度中心视网膜增厚-黄斑水肿的定量评估-都减少了接近90%。改善程度与病程或患者基线年龄之间没有相关性，但基线时房水中血管内皮生长因子(VEGF)水平与改善程度之间存在一定的相关性。这些数据表明，CRVO或BRVO患者视网膜中过度产生的血管内皮生长因子是黄斑水肿的主要原因，并提示需要进一步研究眼内注射雷尼比单抗的疗效。
Macular edema is a major cause of vision loss in patients with central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO). It is not clear how much of the edema is due to hydrodynamic changes from the obstruction and how much is due to chemical mediators. Patients with macular edema due to CRVO (n = 20) or BRVO (n = 20) were randomized to receive three monthly injections of 0.3 or 0.5 mg of ranibizumab. At the primary endpoint, month 3, the median improvement in letters read at 4 m was 17 in the 0.3-mg group and 14 in the 0.5-mg group for CRVO, and 10 and 18, respectively for the BRVO group. Optical coherence tomography (OCT) showed that compared to injections of 0.3 mg, injections of 0.5 mg of ranibizumab tended to cause more rapid reductions of central retinal thickening that lasted longer between injections, but in 3 months, excess central retinal thickening which is a quantitative assessment of the macular edema, was reduced by similar to 90% in all four treatment groups. There was no correlation between the amount of improvement and duration of disease or patient age at baseline, but there was some correlation between the aqueous vascular endothelial growth factor (VEGF) level at baseline and amount of improvement. These data indicate that excess production of VEGF in the retinas of patients with CRVO or BRVO is a major contributor to macular edema and suggest that additional studies investigating the efficacy of intraocular injections of ranibizumab are needed.